Bipolar Disorder

Pathophysiology
Both forms of bipolar disorder are characterized by extreme high and extreme low periods. The highs
are referred to as manic episodes and the lows are referred to as depressive episodes. The major
difference between bipolar 1 and bipolar 2 is the severity of the manic episodes that each type causes.
Bipolar 1 induces mania and depression, while hypomania and depression are caused by bipolar 2.
Possible causes of Bipolar disorders are: hormones, biological factors, psychological or environmental
factors. Chemical imbalances in the brain are thought to arise bipolar disorder in patients. Patients with
bipolar disorder have periods of mania. This is when the patient does not sleep or eat properly. They
may have excessive energy and talk constantly, usually seen with bipolar 1. As the manic episode
progresses, it may turn into psychosis with hallucinations and delusions. The manic episodes may
alternate with episodes of severe depression. It is believed that altered proportions of neurotransmitters
norepinephrine, dopamine, and serotonin are responsible for the disorder.
Treatment Clinical manifestation Labs and Diagnostics
*Mood disorder questionnaire *Decreased need for sleep *ECG, EEG
*Psychiatric counselling *Constant talking *Serum electrolytes
*Mood stabilizers (Lithium, *Racing thoughts *Glucose levels
Lamotrigine) *Easily distracted *Protein levels
*Anticonvulsants *Unusual behaviors *CBC, CMP
(Carbamazepine, Lamictal, *Inflated *Creatinine, BUN
Valproate) OR *Liver enzymes
*Antianxiety: (Clonazepam, *Low self-esteem *Lipid Panel
Lorazepam, Olanzapine, *Loss of interest in usual *Substance abuse
risperidone) activities screening
*Electroconvulsive therapy, *Weight changes
Transcranial magnetic *Fatigue
stimulation *Insomnia
*Valproic Acid for the manic *Excessive sleeping
stimulation *Thoughts of suicide
*Teamwork and safety

Nursing Diagnoses Nursing Considerations

*Hopelessness *Provide decreased stimuli and a
*Disturbed thought process calm/relaxing environment
*Impaired social interaction *Suicidal precautions
*Risk for injury *Encourage patient to identify
*Disturbed sleep pattern stressors and use coping mechanisms